Public Policy is social agreement written down as a universal guide for social action. We at The Policy ThinkShop share information so others can think and act in the best possible understanding of "The Public Interest."

The current Republican victory either threatens healthcare access success or saves the day. Perhaps it depends on what ideas you have to form an opinion on the matter. Thousands of people inherit political and controversial opinions from their parents or grandparents. But this is not our grandparent’s America. Leadership today, and ideas to formulate solutions to our society’s most vexing social and economic challenges, must be as innovative as the ideas our forefathers forged to build our constitution. They broke new ground to form a more perfect union.

America needs help in being more perfect today. We need new ideas to help us support new social investments to address our collective responsibility to make sure that our form of government, and the leaders we put in charge, keep a fair balance regarding the social contract that makes us the greatest nation on earth. Perhaps reading the current book “Scarcity: Why Having Too Little Means So Much,” by Mullainathan and Sharif, could help?

Jus about a year ago an important book was published regarding scarcity. We were all probably a bit busy, so it did not cross our minds. Interestingly, the book is about the very social and psychological reality that caused many of us to miss the opportunity. We just don’t seem to have enough time in the day to do the things we need to do to make our life more manageable, more simple and, perhaps, more enjoyable. Without mentioning the dated and overused thought model, “Maslow’s hierarchy of needs,” we are reminded of a person’s lack of efficacy when overwhelmed by environmental stimuli that dictate how we feel and perhaps what we do. Such is the case in this important book on the effects on our minds and how our mind works when confronted by daily challenges. The mind, the book’s thesis goes, has limits (“bandwidth”), and its focus is bound by our fixation on what matters among the many things coming at us. The book is important for public health, healthcare services and health education, for example, because it gives us a less pejorative and judgmental way to look at people misbehaving. Especially behaving in ways that seem irrational, or worse, lazy or undeserving, to us. Perhaps as health professionals, funders, planner and policy makers, we are distanced from the daily lives and realities of those confronted with our well intentioned helping systems and recommendations. It can be daunting and frustrating. This book may give us hope.

Mullainathan and Sharif elaborate on a conception of the haves and the have nots that is nuanced, insightful and perhaps more pragmatic than any construct we have heretofore seen; Yes, in the war on poverty. To be sure, decades have passed since our last great poverty reform (PRWORA, 1996 or Bill Clinton’s Welfare Reform Law). We now have the ACA reform (Barak Obama’s Law). This second salvo on our nation’s efforts to address the needs of the “have nots” is once again putting the poor under the looking glass. Back in the 90s version we were looking at people, being helped, being too lazy and needing to be made to work while getting help in order to get off of the government dole. Millions of people were thrown off of the welfare rolls and when it was all said and done a Government Accounting Office (GAO) report declared that the majority of people remaining on the rolls were ill and not employable. This was an important report, by “objective” pundits representing the federal government; and you would think that would have been enough to usher in healthcare reform to address the urgent plight of this government policy defined and “vetted” group. It wasn’t.

Perhaps due to our national political discourse and the focus on levels of unemployment that could not longer be explained by the “lazy people on welfare” phenomenon, the nation began to focus on working people, many who were not faring much better than people on welfare. The struggling middle class and the “deserving working poor” became the popular political constituency. The increasingly divided electorate called for new issue that could wedge open the door to a new group that could tip the electoral balance. This need fueled to drive for an electoral strategy focus on new votes and created the conditions and demand for strategies promising to move this demographic to the polls. Enter today’s healthcare reform scenario.

Perhaps this is why healthcare reform remains a political fight with uncertainties and future possibilities for failure. Just as the end of the PRWORA’s success, in throwing the poor of the welfare rolls, may now echo the present reality where we will have disrupted thousands of families’ lives, only to throw them off the insurance rolls.

“Scarcity captures us because it is important, worthy of our attention, but we cannot fully choose when our minds will be riveted. We focus on scarcity even when we do not want to. We think about that impending project not only when we sit down to work on it but also when we are at home trying to help our child with her homework. The same automatic capture that helps us focus becomes a burden in the rest of life. Because we are preoccupied by scarcity, because our minds constantly return to it, we have less mind to give to the rest of life.”

The Policy ThinkShop provides you with the key reports and policy papers needed to help you participate in the current national debate addressing the implementation of the ACA insurance reform and in the ongoing mobilization of the philanthropic sector needed to transform how we view and support our own health and wellbeing within the lifestyle choices available to us in our communities, employment, educational system and civic life.

Building a healthier America will require much more than giving people health insurance cards

Investing in community health makes perfect economic, moral and public health sense. But this lesson is lost on politics. The nation’s corrosive political discourse consistently obfuscates the growing national consensus that healthcare dollars alone cannot give us a healthy society.

RWJF is developing a vision of good health that begins with individuals in their community environments. This new approach to talking about the state of our healthcare system and of the health of our citizens goes beyond the traditional debate about healthcare costs, the need for a more cost-effective healthcare system that focuses on prevention of disease; and it goes beyond the need for access to and delivery of quality healthcare services that lead to improvements in health status for most Americans. This new focus centers on individuals, their health related behaviors and the social context in which those behaviors occur. The idea is that investing in a community environment that promotes a healthy lifestyle will prevent disease and healthcare problems before they arise. This in turn will lessen the burden on our currently expensive and inefficient healthcare system.

The RWJF initiative to promote a healthier America is defined and operationalized in the following report. This vision also coincides with the current interest in ACA healthcare insurance reform. The second report which follows also addresses why all of the states should see the current medicaid expansion as economically beneficial in terms of increased revenue coming from the federal government and costs savings coming directly from their investment in medicaid expansion at the local level.

New Recommendations from the RWJF Commission to Build a Healthier America

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.

No other substance on the planet is so embedded in our happiness and in our suffering like alcohol is. As Americans, we are moving away from some forms of alcohol but are embracing wine with new vigor. The World Health Organization (WHO) recently released an comprehensive report that enumerates alcohol consumption issues and social problems. You can follow the following link provided by The Policy ThinkShop to read the full report.

“Worldwide, 3.3 million deaths in 2012 were due to harmful use of alcohol, says a new report launched by WHO today. Alcohol consumption cannot only lead to dependence but also increases people’s risk of developing more than 200 diseases including liver cirrhosis and some cancers. In addition, harmful drinking can lead to violence and injuries.

The report also finds that harmful use of alcohol makes people more susceptible to infectious diseases such as tuberculosis and pneumonia.

The “Global status report on alcohol and health 2014″ provides country profiles for alcohol consumption in the 194 WHO Member States, the impact on public health and policy responses.

“More needs to be done to protect populations from the negative health consequences of alcohol consumption,” says Dr Oleg Chestnov, WHO Assistant Director-General for Noncommunicable Diseases and Mental Health. “The report clearly shows that there is no room for complacency when it comes to reducing the harmful use of alcohol.”

Some countries are already strengthening measures to protect people. These include increasing taxes on alcohol, limiting the availability of alcohol by raising the age limit, and regulating the marketing of alcoholic beverages.”

Report highlights

The report also highlights the need for action by countries including:

national leadership to develop policies to reduce harmful use of alcohol (66 WHO Member States had written national alcohol policies in 2012);

national awareness-raising activities (nearly 140 countries reported at least one such activity in the past three years);

health services to deliver prevention and treatment services, in particular increasing prevention, treatment and care for patients and their families, and supporting initiatives for screening and brief interventions.

The Polity ThinkShop brings you this important report on the State of our American State

Have unions been dealt yet another blow, now ironically by the well intentioned ACA reform?

If the federal government mandates that business and individuals obtain insurance is this setting a president for the federal government to regulate and mandate worker gains without the use of union muscle?

These are provocative questions, at least for people who still remember the sacrifices that were made to create unions and the horrible conditions that preceded them.

“Last week’s vote by workers at Volkswagen’s Chattanooga, Tenn. plant against joining the United Auto Workers union — despite VW’s tacit encouragement — points up the challenges faced by U.S. organized labor. Even though unions retain much public support, the share of American workers who actually belong to one has been falling for decades and is at its lowest level since the Great Depression.

In a Pew Research Center survey conducted in June 2013, about half (51%) of Americans said they had favorable opinions of labor unions, versus 42% who said they had unfavorable opinions about them. That was the highest favorability rating since 2007, though still below the 63% who said they were favorably disposed toward unions in 2001. In a separate 2012 survey, 64% of Americans agreed that unions were necessary to protect working people (though 57% also agreed that unions had “too much power”).”

If we are going to be successful in improving our healthcare system, we are going to have to make a difference in the quality of healthcare provided, access to care, health literacy on the part of consumers of care; and we will have to make it easier to live a healthier lifestyle for those most at risk. But how can we do this and where do we start?

Any effort that seeks to address healthcare quality and costs, both categories that seem to top the chart for both consumers, payers, political leaders, and policy makers, must address the continuum of prevention, intervention, followup, evaluation, and implementation of findings. The process of true healthcare reform must begin with each individual and the social and economic context in which he or she must navigate (health literacy) to achieve an optimal health lifestyle. The most significant challenge for a culturally diverse society like ours in the area of supporting and addressing lifestyle with the goal of improving health is communication. In the area of healthcare this means optimal interpersonal health communication between provider and service recipient. What do patients who experience communication dissonance in the healthcare encounter think of the physician – patient encounter? That’s where we need to begin.

“Patient-reported experiences of care are an important focus in health disparities research. This study explored the association of patient-reported experiences of care with race and acculturation status in a primary care setting. 881 adult patients (African-American 34%; Hispanic–classified as unacculturated or biculturated–31%; Caucasian 33%; missing race 2%), in outpatient Family Medicine clinics, completed a written survey in Spanish or English. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician & Group (CAG) Survey Adult Primary Care instrument was used for experiences of care and Short Form-12 survey for health status. Controlling for other variables, race and acculturation were significantly associated with several CAG subscales. Hispanic patients gave significantly higher ratings for care experiences and expressed greater interest in shared decision making. Selected patient-reported measures of care are associated with patients’ race and acculturation status (for Hispanic patients). We discuss implications for both provision and measurement of quality care.”

Half the country seems to be moving along with ACA reform and the other half are paying a price for not fully participating. According to an Urban Institute report released this month, the nearly half of states that have not expanded medicaid under ACA implementation may have missed an important economic boost during these tough economic times.

“In the 24 states that have not expanded Medicaid, 6.7 million residents are projected to remain uninsured in 2016 as a result. These states are foregoing $423.6 billion in federal Medicaid funds from 2013 to 2022, which will lessen economic activity and job growth. Hospitals in these 24 states are also slated to lose a $167.8 billion (31 percent) boost in Medicaid funding that was originally intended to offset major cuts to their Medicare and Medicaid reimbursement.

A review of state-level fiscal studies found comprehensive analyses from 16 diverse states. Each analysis concluded that expansion helps state budgets. State savings and new state revenues exceeded increased state Medicaid expenses, with the federal government paying a high share of expansion costs. Even if future lawmakers reduce federal Medicaid spending, high federal matching rates are likely to remain at the ACA’s enhanced rates, given historic patterns. Facing bipartisan gubernatorial opposition, Congress lowered the federal share of Medicaid spending just once since 1980, while cutting Medicaid eligibility, services, and provider payments more than 100 times. Medicaid expansion thus offers significant state-level fiscal and economic benefits, along with increased health coverage.”

The Policy ThinkShop calls your attention to a very hopeful challenge being proposed by key health leaders and philanthropists nationwide and led by a tremendous investment and vision from the leadership of the RWJ Foundation.

A quote from our Policy ThinkShop comments on this issue:

“After many years of personal, familial and community health experience in the private and public health sectors, we can see real hope and investment in these words and nascent vision from Risa–namely that corporate good is finally being aligned with social good in the areas of personal, family and community health.

The hospital, pharmaceutical and academic sectors have traditionally focused on health as a disease problem and the various commodities and professions associated with the industry that evolved around personal, family, community and public health problems in general. Disease and social suffering have too often been rapped in the injurious cloak of stigma and disdain. Too often we see individual health problems in pejorative ways that lead us away from shared solutions because of the more salient confounding factors we “like” to see. Perhaps empowering the sick and the needy so that they have commitment and a voice to join the proposed transformation of our healthcare culture is a starting place. This can begin through improved interpersonal health communication processes in our health professions at the level of service, for example. It can also be complemented by a health department, by community, by neighborhood initiative that addresses health literacy efficacy on the part of parents, mothers and youth.”

Does your community relations model incorporate new technologies, social media and senior citizens? Why not? Is your marketing vision inclusive of recent technological change and all its potential? Do you see technology as something that is inherently for the young? Think again…

When it comes to community organizing, community building and solving local problems don’t leave seniors out. Do not assume that age alone is keeping baby boomers out of the social scene. According to PEW there is a growing potential in the way seniors are using new technology and it may have very positive implications for your community organizing goals …

As of April 2012, 53% of American adults ages 65 and older use the internet or email. Though these adults are still less likely than all other age groups to use the internet, the latest data represent the first time that half of seniors are going online. After several years of very little growth among this group, these gains are significant.

Overall, 82% of all American adults ages 18 and older say they use the internet or email at least occasionally, and 67% do so on a typical day.

Once online, most seniors make internet use a regular part of their lives.

For most online seniors, internet use is a daily fixture in their lives. Among internet users ages 65 and older, 70% use the internet on a typical day. (Overall, 82% of all adult internet users go online on an average day.)

After age 75, internet and broadband use drops off significantly.

Internet usage is much less prevalent among members of the “G.I. Generation” (adults who are currently ages 76 and older)1 than among other age groups. As of April 2012, internet adoption among this group has only reached 34%, while home broadband use has inched up to 21%.

Seven in ten seniors own a cell phone, up from 57% two years ago.

A growing share of seniors own a cell phone. Some 69% of adults ages 65 and older report that they have a mobile phone, up from 57% in May 2010. Even among those currently ages 76 and older, 56% report owning a cell phone of some kind, up from 47% of this generation in 2010. Despite these increases, however, older adults are less likely than other age groups to own these devices. Some 88% of all adults own a cell phone, including 95% of those ages 18-29.

One in three online seniors uses social networking sites like Facebook and LinkedIn.

Social networking site use among seniors has grown significantly over the past few years: From April 2009 to May 2011, for instance, social networking site use among internet users ages 65 and older grew 150%, from 13% in 2009 to 33% in 2011. As of February 2012, one third (34%) of internet users ages 65 and older use social networking sites such as Facebook, and 18% do so on a typical day. Among all adult internet users, 66% use social networking sites (including 86% of those ages 18-29), with 48% of adult internet users making use of these sites on a typical day.

By comparison, email use continues to be the bedrock of online communications for seniors. As of August 2011, 86% of internet users ages 65 and older use email, with 48% doing so on a typical day. Among all adult internet users, 91% use email, with 59% doing so on a typical day.”

“Marketing is rapidly becoming one of the most technology-dependent functions in business. In 2012 the research and consulting firm Gartner predicted that by 2017, a company’s chief marketing officer would be spending more on technology than its chief information officer was. That oft-quoted claim seems more credible every day.A new type of executive is emerging at the center of the transformation: the chief marketing technologist. CMTs are part strategist, part creative director, part technology leader, and part teacher. Although they have an array of titles—Kimberly-Clark has a “global head of marketing technology,” while SAP has a “business information officer for global marketing,” for example—they have a common job: aligning marketing technology with business goals, serving as a liaison to IT, and evaluating and choosing technology providers. About half are charged with helping craft new digital business models as well.Regardless of what they’re called, the best CMTs set a technology vision for marketing. They champion greater …”

The Kaiser Family Foundation has released its first survey of the population finding new health coverage under the recently implemented ACA reform. The survey delineates two main groups taking advantage of the increased access to health insurance: those who had non-group coverage and those who had no insurance at all. The experiences of these two groups may prove important, the report goes on to say, with significant implications on how the success of the ACA reform is judged.

Apparently, the success of the ACA reform in brining people into the insured fold may be limited by financial literacy, insurance literacy, and health literacy deficits evident in the Kaiser Family Foundation survey.

A preliminary read of the survey report findings by The Policy ThinkShop points to an emergent need to address health literacy in the newly covered group in order to ensure that coverage recipients understand how to take advantage of their presumed efficacy in the insurance market and in their presumed increased access to healthcare itself and cost saving prevention health services. According to the survey:

“Health insurance is complicated, and many previous studies have documented gaps in health insurance literacy among consumers. The survey finds evidence of this among those who purchase their own coverage, with many respondents unable to answer some basic questions about their plans. For example, nearly one in five non-group enrollees (18 percent) say they don’t know the amount of their monthly premium and almost four in ten (37 percent) don’t know the amount of their annual deductible. Among those with ACA-compliant plans, three in ten (30 percent) say they don’t know the metal level of their plan (platinum, gold, silver or bronze), and among those who report getting a government subsidy to defray their premium cost, nearly half (47 percent) couldn’t say what the amount of the subsidy is.”

The survey report goes on to highlight the segment of the population surveyed who are more privileged because of their prior experience obtaining insurance:

“Some groups are more knowledgeable than others, including college graduates, those with higher incomes, and small business owners. Plan switchers, who likely have more experience buying coverage in the non-group market, are also more likely than those who were previously uninsured to be able to report the metal level of their plan and their premium and deductible amounts.”

“January 1, 2014 marked the beginning of several provisions of the Affordable Care Act ACA making significant changes to the non-group insurance market, including new rules for insurers regarding who they must cover and what they can charge, along with the opening of new Health Insurance Marketplaces also known as “Exchanges” and the availability of premium and cost-sharing subsidies for individuals with low to moderate incomes. Data from the Department of Health and Human Services and others provide some insight into how many people purchased insurance using the new Marketplaces and the types of plans they picked, but much remains unknown about changes to the non-group market as a whole. The Kaiser Family Foundation Survey of Non-Group Health Insurance Enrollees is the first in a series of surveys taking a closer look at the entire non-group market. This first survey was conducted from early April to early May 2014, after the close of the first ACA open enrollment period. It reports the views and experience of all non-group enrollees, including those with coverage obtained both inside and outside the Exchanges, and those who were uninsured prior to the ACA as well as those who had a previous source of coverage non-group or otherwise.”

Social Media is interactive, sustainable and deliciously repetitive … This means you can use it to promote and sustain messages, conversations and eventually more easily sustained marketing relationships with your customers.

The Policy ThinkShop brings your attention to this exemplary story about promoting in the age of social media …

“If you had a book coming out, and you were considering how to get people excited to buy it, read it, and talk about it, which would be most valuable to you:1 a 3-minute segment about your book which is long by TV news standards, including a close-up shot of the cover, on primetime CNN. . .2 a 1,000 word piece you wrote on a topic related to your book, published in the Sunday opinion section of America’s newspaper of record, the New York Times, which reaches the #6 most emailed piece on NYTimes.com within a day. . .3 a guest post you wrote, published on the blog of one lone dude in SF obsessed with fat loss, female orgasms, and lifting Russian kettle bells?If your goal was to cause a lightning storm of book sales, you should pick #3. I know—I did all three.”

Like this:

At the Policy ThinkShop we are constantly trying to discover and share the most comprehensive and reliable public policy resources available to support you in your efforts to master specific policy areas. One of these areas which impacts every aspect of our personal, public and private lives is education policy.

The American Educational Research Association (AERA) is a good resource for everythingeducation policy:

“As part of its mission to “promote the use of research to improve education and serve the public good,” AERA has enlisted the expertise of its members to provide comment on Supreme Court cases and federal legislation to support this mission.

Amicus BriefsAERA has provided scientific evidence in legal briefs submitted to the Supreme Court in cases involving social justice in education.

Fisher v. University of Texas at Austin 2012: Amicus Brief Brings Education Research to Bear in Major Affirmative Action Case.

Parents Involved in Community Schools v. Seattle School District No. 1 and Meredith v. Jefferson County Board of Education 2006: Both cases, ruled on jointly by the Supreme Court, focused on district policies encouraging integration that allowed for race to be used as a “tiebreaker” for public choice of high schools in Seattle and as a factor in determining elementary school assignments in Louisville.

Grutter v. Bollinger 2003: Challenge of University of Michigan Law School admissions policy that the plaintiff unsuccessfully argued gave applicants from underrepresented minority groups a greater likelihood of being accepted than white applicants.

Gratz v. Bollinger 2003: Challenge of University of Michigan undergraduate admissions policy that allocated a certain number of points to applicants from underrepresented minority groups.”

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